Provider Demographics
NPI:1386643401
Name:MARTIN, JENNIFER NICOLE (MSN, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, ARNP
Mailing Address - Street 1:3000 HUNTERS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6901
Mailing Address - Country:US
Mailing Address - Phone:407-857-2502
Mailing Address - Fax:407-857-1855
Practice Address - Street 1:3000 HUNTERS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6901
Practice Address - Country:US
Practice Address - Phone:407-857-2502
Practice Address - Fax:407-857-1855
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9165051363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305957000Medicaid
Q06954Medicare UPIN
FLYO43XWMedicare PIN
FLYO43XXMedicare PIN